Gene therapy for amyotrophic lateral sclerosis and other spinal cord disorders

ABSTRACT

This disclosure provides methods and compositions for treating disorders or injuries that affect motor function and control in a subject. In one aspect, the invention a transgene product is delivered to a subject&#39;s spinal cord by administering a recombinant viral vector containing the transgene to the spinal cord. The viral vector delivers the transgene which expresses the encoded recombinant viral gene product. The viral gene product comprises HIF1-alpha. Also provided are compositions for delivery of a transgene product to a subject&#39;s spinal cord.

FIELD OF THE INVENTION

The present invention relates to compositions and methods for treatingdisorders affecting a subject's motor function and in particular, motorfunction affected by disease or injury to the brain and/or spinal cord.

BACKGROUND OF THE INVENTION

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerativecondition involving the loss of large motor neurons in the brain andspinal cord. It is characterized by progressive weakness, atrophy andspasticity, leading to paralysis and respiratory failure within fiveyears of onset. Familial ALS accounts for 10% of all ALS cases;approximately 25% of these cases are due to mutations in the Cu/Znsuperoxide dismutase gene (SOD1) [1]. To date 109 different mutationshave been identified in the SOD1 gene; these span all five exons [2].Besides very rare mutations in genes for heavy neurofilament chain(NFH), dynactin, vesicular binding protein 1 gene and the ALSIN gene,SOD1 is the only major ALS susceptibility locus identified. SOD1 is amainly cytoplasmic enzyme that catalyzes the breakdown of superoxideions to oxygen and hydrogen peroxide, which in turn is degraded byglutathione peroxidase or catalase to form water. Several lines ofevidence argue that the mutant SOD1 protein is neurotoxic through anacquired, adverse function that entails both oxidative pathology andprotein aggregation, with secondary disturbances of glutamatemetabolism, mitochondrial function, axonal transport and calciumhomeostasis [3]. That mutant SOD1 is toxic is strongly supported by theobservation that transgenic expression of high levels of mutant SOD1protein in mice produces a motor neuron disease phenotype, with age ofonset and disease duration dependent on copy number [4].

To date, few therapeutic interventions have altered the motor neuronphenotype in the transgenic ALS mice. Although more than 100 smallmolecules have been tested to date, few have had even a marginal benefit(e.g. riluzole [5], celecoxib [6], arimoclomol [7]). By contrast, someforms of protein therapy have been beneficial. Thus, improvement insurvival was produced by administering insulin-like growth factor 1either transgenically [8] or through AAV2-delivery via IM injection andsubsequent retrograde axonal transport to motor nerves [9]. Two otherproteins that have shown therapeutic promise as neuroprotective agentsare erythropoietin [10] and vascular endothelial factor (VEGF) [11, 12].The latter is of interest because genetic analysis has implicatedhypomorphic variants in the VEGF gene as a risk factor for ALS [13].Moreover, mice that lack hypoxia-responsive promoter elements develop aslowly progressive motor neuron disease [14]. Subsequently, it wasdocumented that lentiviral delivery of VEGF to the spinal cord of ALSmice delays death [15]. Two independent investigators have reported thatinfusion of VEGF into the cerebrospinal fluid in ALS mice [16] and rats[17] also slow the disease course.

Gene therapy is an emerging treatment modality for disorders affectingthe central nervous system (CNS). CNS gene therapy has been facilitatedby the development of viral vectors capable of effectively infectingpost-mitotic neurons. The central nervous system is made up of thespinal cord and the brain. The spinal cord conducts sensory informationfrom the peripheral nervous system to the brain and conducts motorinformation from the brain to various effectors. For a review of viralvectors for gene delivery to the central nervous system, see Davidson etal. (2003) Nature Rev. 4:353-364.

Adeno-associated virus (AAV) vectors are considered useful for CNS genetherapy because they have a favorable toxicity and immunogenicityprofile, are able to transduce neuronal cells, and are able to mediatelong-term expression in the CNS (Kaplitt et al. (1994) Nat. Genet.8:148-154; Bartlett et al. (1998) Hum. Gene Ther. 9:1181-1186; andPassini et al. (2002) J. Neurosci. 22:6437-6446).

One useful property of AAV vectors lies in the ability of some AAVvectors to undergo retrograde and/or anterograde transport in neuronalcells. Neurons in one brain region are interconnected by axons to distalbrain regions thereby providing a transport system for vector delivery.For example, an AAV vector may be administered at or near the axonterminals of neurons. The neurons internalize the AAV vector andtransport it in a retrograde manner along the axon to the cell body.Similar properties of adenovirus, HSV, and pseudo-rabies virus have beenshown to deliver genes to distal structures within the brain (Soudas etal. (2001) FASEB J. 15:2283-2285; Breakefield et al. (1991) New Biol.3:203-218; and deFalco et al. (2001) Science, 291:2608-2613).

Several groups have reported that the transduction of the brain by AAVserotype 2 (AAV2) is limited to the intracranial injection site (Kaplittet al. (1994) Nat. Genet. 8:148-154; Passini et al. (2002) J. Neurosci.22:6437-6446; and Chamberlin et al. (1998) Brain Res. 793:169-175).Recent reports suggest that retrograde axonal transport of neurotrophicviral vectors, including AAV and lentiviral vectors, can also occur inselect circuits of the normal rat brain (Kaspar et al. (2002) Mol. Ther.5:50-56; Kasper et al. (2003) Science 301:839-842 and Azzouz et al.(2004) Nature 429:413-417. Roaul et al. (2005) Nat. Med. 11(4):423-428and Ralph et al. (2005) Nat. Med. 11(4):429-433 report thatintramuscular injection of lentivirus expressing silencing human Cu/Znsuperoxide dismutase (SOD 1) interfering RNA retarded disease onset ofamyotrophic lateral sclerosis (ALS) in a therapeutically relevant rodentmodel of ALS.

Cells transduced by AAV vectors may express a therapeutic transgeneproduct, such as an enzyme or a neurotrophic factor, to mediatebeneficial effects intracellularly. These cells may also secrete thetherapeutic transgene product, which may be subsequently taken up bydistal cells where it may mediate its beneficial effects. This processhas been described as cross-correction (Neufeld et al. (1970) Science169:141-146).

There is a need in the art for compositions and methods to treatdysfunction of the spinal cord that result in loss of motor function inhuman patients.

SUMMARY OF THE INVENTION

In one aspect, the invention provides a method of treating a mammal witha motor neuron disorder by direct spinal cord injection of aneurotrophic vector encoding for a therapeutic molecule. In oneembodiment, the neurothrophic vector is a recombinant expression vectorencoding HIF1-alpha where the vector is a recombinant adeno-associatedvirus (AAV). It is delivered by direct injection into the parenchyma ofthe spinal cord of a mammal with a motor neuron disorder. The lifeexpectancy of the mammal is thereby extended.

In another aspect the invention provides a method of treating a humanpatient with a motor neuron disorder by direct spinal cord injection ofa neurotrophic vector encoding for a therapeutic molecule. In oneembodiment, a recombinant AAV vector encoding HIF1-alpha fused to NFκBis delivered to a plurality of sites in spinal cord of a human patientwith a motor neuron disorder. Life expectancy of the human patient isthereby extended.

According to another embodiment of the invention a recombinant AAVvector encoding HIF1-alpha is provided for treating patients with amotor neuron disorder. The motor neuron disorder may be ALS. The AAVvector may be a recombinant AAV2/7 or AAV2/8 vector encoding HIF1-alpha.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the invention as claimed.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows spinal cord vector genome delivery via different deliverymodes and vector pseudotypes.

FIG. 2 shows brain vector genome delivery via different delivery modesand vector pseudotypes.

FIG. 3 shows the number of vector genomes that were delivered to themuscle following intramuscular injection of the AAV vectors.

FIG. 4 shows gene expression of EPO, VEGF, and IGF-1 followingtransduction of a mouse brain with an AAV vector encoding for HIF-1alpha NF-κB.

FIG. 5 shows a Kaplan-Meier survival curve that demonstrates astatistically significant (p=0.033) increase in survival of ALS mousefollowing intraspinal administration of AAV2/8 Hif1aNF-kB (133 dayssurvival in control mice vs 139 day survival in Hif-1 alpha NF-κBtreated mice.)

FIG. 6 shows in situ hybridization for Hif-1alpha NF-κB in the spinalcords of ALS mice treated with AAV2/8 Hif1aNFkB suggests thattransduction was seen mainly in the lumbar region of the spinal cord.Animals 6817, 6715, and 6389 were treated with AAV2/8 Hif1aNFkB; animal1460 was a control animal.

DETAILED DESCRIPTION OF THE INVENTION

In order that the present invention may be more readily understood,certain terms are first defined. Additional definitions are set forththroughout the detailed description.

The practice of the present invention will employ, unless otherwiseindicated, conventional techniques of immunology, molecular biology,microbiology, cell biology and recombinant DNA, which are within theskill of the art. See, e.g., Sambrook, Fritsch and Maniatis, MOLECULARCLONING: A LABORATORY MANUAL, 2^(nd) edition (1989); CURRENT PROTOCOLSIN MOLECULAR BIOLOGY (F. M. Ausubel, et al. eds., (1987)); the seriesMETHODS IN ENZYMOLOGY (Academic Press, Inc.): PCR 2: A PRACTICALAPPROACH (M. J. MacPherson, B. D. Hames and G. R. Taylor eds. (1995)),Harlow and Lane, eds. (1988) ANTIBODIES, A LABORATORY MANUAL, and ANIMALCELL CULTURE (R. I. Freshney, ed. (1987)).

As used in the specification and claims, the singular form “a”, “an” and“the” include plural references unless the context clearly dictatesotherwise. For example, the term “a cell” includes a plurality of cells,including mixtures thereof.

As used herein, the term “comprising” is intended to mean that thecompositions and methods include the recited elements, but not excludingothers. “Consisting essentially of” when used to define compositions andmethods, shall mean excluding other elements of any essentialsignificance to the combination. Thus, a composition consistingessentially of the elements as defined herein would not exclude tracecontaminants from the isolation and purification method andpharmaceutically acceptable carriers, such as phosphate buffered saline,preservatives, and the like. “Consisting of” shall mean excluding morethan trace elements of other ingredients and substantial method stepsfor administering the compositions of this invention. Embodimentsdefined by each of these transition terms are within the scope of thisinvention.

All numerical designations, e.g., pH, temperature, time, concentration,and molecular weight, including ranges, are approximations which arevaried (+) or (−) by increments of 0.1. It is to be understood, althoughnot always explicitly stated that all numerical designations arepreceded by the term “about”. It also is to be understood, although notalways explicitly stated, that the reagents described herein are merelyexemplary and that equivalents of such are known in the art.

The term “transgene” refers to a polynucleotide that is introduced intoa cell of and is capable of being transcribed into RNA and optionally,translated and/or expressed under appropriate conditions. In one aspect,it confers a desired property to a cell into which it was introduced, orotherwise leads to a desired therapeutic or diagnostic outcome.

The terms “genome particles (gp),” or “genome equivalents,” as used inreference to a viral titer, refer to the number of virions containingthe recombinant AAV DNA genome, regardless of infectivity orfunctionality. The number of genome particles in a particular vectorpreparation can be measured by procedures such as described in theExamples herein, or for example, in Clark et al. (1999) Hum. Gene Ther.,10:1031-1039; Veldwijk et al. (2002) Mol. Ther., 6:272-278.

The terms “infection unit (iu),” “infectious particle,” or “replicationunit,” as used in reference to a viral titer, refer to the number ofinfectious and replication-competent recombinant AAV vector particles asmeasured by the infectious center assay, also known as replicationcenter assay, as described, for example, in McLaughlin et al. (1988) J.Virol., 62:1963-1973.

The term “transducing unit (tu)” as used in reference to a viral titer,refers to the number of infectious recombinant AAV vector particles thatresult in the production of a functional transgene product as measuredin functional assays such as described in Examples herein, or forexample, in Xiao et al. (1997) Exp. Neurobiol., 144:113-124; or inFisher et al. (1996) J. Virol., 70:520-532 (LFU assay).

The terms “therapeutic,” “therapeutically effective amount,” and theircognates refer to that amount of an RNA, DNA or expression product ofDNA and/or RNA that results in prevention or delay of onset oramelioration of symptoms of in a subject or an attainment of a desiredbiological outcome, such as correction of neuropathology, e.g., cellularpathology associated with a motor neuronal disease such as ALS. The term“therapeutic correction” refers to that degree of correction thatresults in prevention or delay of onset or amelioration of symptoms in asubject. The effective amount can be determined by known empiricalmethods.

A “composition” is also intended to encompass a combination of activeagent and another carrier, e.g., compound or composition, inert (forexample, a detectable agent or label) or active, such as an adjuvant,diluent, binder, stabilizer, buffers, salts, lipophilic solvents,preservative, adjuvant or the like. Carriers also include pharmaceuticalexcipients and additives proteins, peptides, amino acids, lipids, andcarbohydrates (e.g., sugars, including monosaccharides, di-, tri-,tetra-, and oligosaccharides; derivatized sugars such as alditols,aldonic acids, esterified sugars and the like; and polysaccharides orsugar polymers), which can be present singly or in combination,comprising alone or in combination 1-99.99% by weight or volume.Exemplary protein excipients include serum albumin such as human serumalbumin (HSA), recombinant human albumin (rHA), gelatin, casein, and thelike. Representative amino acid/antibody components, which can alsofunction in a buffering capacity, include alanine, glycine, arginine,betaine, histidine, glutamic acid, aspartic acid, cysteine, lysine,leucine, isoleucine, valine, methionine, phenylalanine, aspartame, andthe like. Carbohydrate excipients are also intended within the scope ofthis invention, examples of which include but are not limited tomonosaccharides such as fructose, maltose, galactose, glucose,D-mannose, sorbose, and the like; disaccharides, such as lactose,sucrose, trehalose, cellobiose, and the like; polysaccharides, such asraffinose, melezitose, maltodextrins, dextrans, starches, and the like;and alditols, such as mannitol, xylitol, maltitol, lactitol, xylitolsorbitol (glucitol) and myoinositol.

The term carrier further includes a buffer or a pH adjusting agent;typically, the buffer is a salt prepared from an organic acid or base.Representative buffers include organic acid salts such as salts ofcitric acid, ascorbic acid, gluconic acid, carbonic acid, tartaric acid,succinic acid, acetic acid, or phthalic acid; Tris, tromethaminehydrochloride, or phosphate buffers. Additional carriers includepolymeric excipients/additives such as polyvinylpyrrolidones, ficolls (apolymeric sugar), dextrates (e.g., cyclodextrins, such as2-hydroxypropyl-.quadrature.-cyclodextrin), polyethylene glycols,flavoring agents, antimicrobial agents, sweeteners, antioxidants,antistatic agents, surfactants (e.g., polysorbates such as “TWEEN 20”and “TWEEN 80”), lipids (e.g., phospholipids, fatty acids), steroids(e.g., cholesterol), and chelating agents (e.g., EDTA).

As used herein, the term “pharmaceutically acceptable carrier”encompasses any of the standard pharmaceutical carriers, such as aphosphate buffered saline solution, water, and emulsions, such as anoil/water or water/oil emulsion, and various types of wetting agents.The compositions also can include stabilizers and preservatives and anyof the above noted carriers with the additional provision that they beacceptable for use in vivo. For examples of carriers, stabilizers andadjuvants, see Martin REMINGTON'S PHARM. SCI., 15th Ed. (Mack Publ. Co.,Easton (1975) and Williams & Williams, (1995), and in the “PHYSICIAN'SDESK REFERENCE”, 52^(nd) ed., Medical Economics, Montvale, N.J. (1998).

A “subject,” “individual” or “patient” is used interchangeably herein,which refers to a vertebrate, preferably a mammal, more preferably ahuman. Mammals include, but are not limited to, murines, rats, simians,humans, farm animals, sport animals, and pets.

A “control” is an alternative subject or sample used in an experimentfor comparison purpose. A control can be “positive” or “negative.” Forexample, where the purpose of the experiment is to determine acorrelation of an altered expression level of a gene with a particulartype of pathology (see ALS, for example, infra), it is generallypreferable to use a positive control (a subject or a sample from asubject, carrying such alteration and exhibiting symptoms characteristicof that disease), and a negative control (a subject or a sample from asubject lacking the altered expression and clinical symptom of thatdisease).

“Differentially expressed” as applied to a gene, refers to thedifferential production of the mRNA transcribed from the gene or theprotein product encoded by the gene. A differentially expressed gene maybe overexpressed or underexpressed as compared to the expression levelof a normal or control cell. In one aspect, it refers to a differentialthat is at least 1.5 times, or at least 2.5 times, or alternatively atleast 5 times, or alternatively at least 10 times higher or lower thanthe expression level detected in a control sample. The term“differentially expressed” also refers to nucleotide sequences in a cellor tissue which are expressed where silent in a control cell or notexpressed where expressed in a control cell.

As used herein, the term “modulate” means to vary the amount orintensity of an effect or outcome, e.g., to enhance, augment, diminishor reduce.

As used herein the term “ameliorate” is synonymous with “alleviate” andmeans to reduce or lighten. For example one may ameliorate the symptomsof a disease or disorder by making them more bearable.

In aspects where gene transfer is mediated by a DNA viral vector, suchas an adenovirus (Ad) or adeno-associated virus (AAV), a vectorconstruct refers to the polynucleotide comprising the viral genome orpart thereof, and a transgene. Adenoviruses (Ads) are a relatively wellcharacterized, homogenous group of viruses, including over 50 serotypes.See, e.g., International PCT Application No. WO 95/27071. Ads are easyto grow and do not require integration into the host cell genome.Recombinant Ad derived vectors, particularly those that reduce thepotential for recombination and generation of wild-type virus, have alsobeen constructed. See, International PCT Application Nos. WO 95/00655and WO 95/11984. Wild-type AAV has high infectivity and specificityintegrating into the host cell's genome. See, Hermonat and Muzyczka(1984) Proc. Natl. Acad. Sci. USA 81:6466-6470 and Lebkowski, et al.(1988) Mol. Cell. Biol. 8:3988-3996.

HIF-1 is a heterodimeric protein composed of two sub-units: (i) aconstitutively expressed beta (β) subunit (shared by other relatedtranscription factors) and (ii) an alpha (α) subunit (see, e.g., WO96/39426 describing the affinity purification and molecular cloning ofHIF-1α) whose accumulation is regulated by a post-translationalmechanism such that high levels of the alpha subunit can only bedetected during hypoxic conditions. Both subunits are members of thebasic helix-loop-helix (bHLH)-PAS family of transcription factors. Thesedomains regulate DNA binding and dimerization. The transactivationdomain is thought to reside in the C-terminus of the protein.

HIF-1 is involved in the regulation of a number of target genes (seee.g., Bracken et al., Cell. Mol. Life Sci. 60 (2003) 1376-1393 for areview of hypoxia inducible factors). Among the target genes for HIF-1are VEGF and erythropoietin.

To stabilize the hypoxia inducible factor protein under normoxicconditions and to provide strong, constitutive transcriptionalactivation, a hybrid/chimeric fusion protein consisting of theDNA-binding and dimerization domains from HIF-1α at the amino terminus,and a functional transcriptional activator domain of a transcriptionalactivator protein at the carboxy terminus is utilized. To create thisfusion protein, the endogenous transactivation domain of HIF-1α isreplaced by a heterologous transactivation domain. In one embodiment,the transactivation domain is from the Herpes Simplex Virus (HSV) VP 16protein. This is termed herein a HIF1 alpha-VP16 construct or fusionconstruct. In another embodiment, the transactivation domain is theNF-κB transactivation domain, which may be the human NF-κBtransactivation domain. This is termed herein a HIF1alpha-NFκB constructor fusion construct. Any mammalian HIF1-alpha coding sequence can beused. The heterologous transactivation domain may also be one of theyeast transcription factors such as GAL4 and GCN4. HIF-1α constructscomprising human coding sequences may be advantageously used fordelivery to humans.

Hypoxia (a state in which tissue or cellular O₂ demand exceeds supply)is a powerful modulator of gene expression. The physiologic response tohypoxia involves enhanced erythropoiesis (Jelkman, Physiol. Rev.72:449-489 (1992)), neovascularization in ischemic tissues (White etal., Circ. Res. 71:1490-1500 (1992)) and a switch to glycolysis-basedmetabolism (Wolfe et al., Eur. J. Biochem. 135:405-412 (1983)). Theseadaptive responses either increase O₂ delivery or activate alternatemetabolic pathways that do not require O₂. The gene products involved inthese processes include, for example: (i) EPO, encoding erythropoietin,the primary regulator of erythropoiesis and thus a major determinant ofblood O₂-carrying capacity (Jiang et al., J. Biol. Chem.271(30):17771-78 (1996)); (ii) VEGF, encoding vascular endothelialgrowth factor, a primary regulator of angiogenesis and thus a majordeterminant of tissue perfusion (Levy et al., J. Biol. Chem. 270:13333(1995); Liu et al., Circ. Res. 77:638 (1995); Forsythe et al., Mol.Cell. Biol. 16:4604 (1996)); (iii) ALDA, ENO1, LDHA, PFKL, and PGK1,encoding the glycolytic enzymes aldolase A, enolase 1, lactatedehydrogenase A, phosphofructokinase L, and phosphoglycerate kinase 1,respectively, which provide a metabolic pathway for ATP generation inthe absence of O₂ (Firth et al., Proc. Natl. Acad. Sci., USA 91:6496(1994); Firth et al., J. Biol. Chem. 270:21021 (1995); Semenza et al.,J. Biol. Chem. 269:23757 (1994)); and (iv) HO1 and iNOS, encoding hemeoxygenase 1 and inducible nitric oxide synthase, which are responsiblefor the synthesis of the vasoactive molecules carbon monoxide and nitricoxide, respectively (Lee et al., J. Biol. Chem. 272:5375; Melillo et al.J. Exp. Med. 182:1683 (1995)).

An important mediator of these responses is the interaction of atranscriptional complex comprising a DNA-binding hypoxia-induciblefactor protein, with its cognate DNA recognition site, ahypoxia-responsive element (HRE) located within the promoter/enhancerelements of hypoxia-inducible genes. HREs consist of anhypoxia-inducible factor protein binding site (that contains the coresequence 5′-CGTG-3′) as well as additional DNA sequences that arerequired for function, which in some elements includes a second bindingsite.

In one embodiment, the hypoxia-inducible factor protein is HIF-1α (e.g.,human HIF-1□). In another embodiment, the DNA-binding domain of HIF-1

comprises amino acids 1-390 of human HIF-1α.

In one embodiment, the protein domain capable of transcriptionalactivation is not derived from a hypoxia-inducible factor protein. Inanother embodiment, the protein domain capable of transcriptionalactivation is derived from a protein selected from the group consistingof: HSV VP16; NF□B; a heat shock factor; p53; fos; v-jun; factor EF-C;HIV tat; HPV E2; Ad E1α; Spi; AP1; CTF/NF1; E2F1; HAP1; HAP2; MCM1;PHO2; GAL4; GCN4; and GAL11.

In one embodiment, the protein domain capable of transcriptionalactivation is synthetic. In another embodiment, the hypoxia-induciblefactor protein is HIF-1α (e.g., human HIF-1α and the protein domaincapable of transcriptional activation is a transcriptional activationdomain from HSV VP16. In still another embodiment, the hypoxia-induciblefactor protein is HIF-1α (e.g., human HIF-1α and the protein domaincapable of transcriptional activation is a transcriptional activationdomain from NF□B.

In one embodiment, the invention is a method of treating aneurodegenerative disorder in a subject, including ALS, comprisingadministering to the subject an effective amount of a nucleic acidmolecule encoding a biologically active chimeric transactivator proteincomprising the DNA-binding domain of a hypoxia-inducible factor proteinand a protein domain capable of transcriptional activation.

In a preferred embodiment, the nucleic acid molecule encoding abiologically active chimeric transactivator protein comprises theDNA-binding domain of a hypoxia-inducible factor (HIF) protein and aprotein domain capable of transcriptional activation.

HIF-1 is a heterodimeric protein composed of two subunits: (i) aconstitutively expressed beta (β) subunit also known as aryl hydrocarbonnuclear translocator (ARNT) (which is shared by other relatedtranscription factors (e.g., the dioxin/aryl hydrocarbon receptor(DR/AhR)); and (ii) an alpha (α) subunit (see, e.g., WO 96/39426,International Application No. PCT/US96/10251 describing the recentaffinity purification and molecular cloning of HIF-1α) whoseaccumulation is regulated by a post-translational mechanism such thathigh levels of the alpha subunit can only be detected during hypoxicconditions. Both subunits are members of the basic helix-loop-helix(bHLH)-PAS family of transcription factors. These domains regulate DNAbinding and dimerization. The transactivation domain resides in theC-terminus of the protein. The basic region consists of approximately 15predominantly basic amino acids responsible for direct DNA binding. Thisregion is adjacent to two amphipathic a helices, separated by a loop ofvariable length, which forms the primary dimerization interface betweenfamily members (Moore, A. W., et al., Proc. Natl. Acad. Sci. USA97:10436-41 (2000)). The PAS domain, which is named after the firstthree proteins in which it was identified (Per, ARNT and Sim),encompasses 200-300 amino acids containing two loosely conserved,largely hydrophobic regions approximately 50 amino acids, designated PASA and PAS B.

Whereas, HIF-1β (ARNT) is expressed constitutively at a high level,accumulation of HIF-1 in the cell is sensitive to O₂ concentration, suchthat high levels are detected only during hypoxia. This observation hasled to a proposed mechanism for target gene activation whereby O₂concentration is detected by a sensor protein and through a complexsignaling mechanism leads to stabilization of the HIF-1αc subunit.HIF-1α is then available to complex with HIF-1β and bind selectively toHRE sites in the promoter/enhancer of the target gene(s). Regions of theHIF-1α protein involved in conferring this response are thought tocoincide with regions involved in transactivation.

Induction of HIF-1 activity in response to hypoxia is thought to occurvia stabilization of the HIF-1α protein. Regions of HIF-1α involved inthis response have been localized to the C-terminus of the protein andoverlap the transactivation domain. For example, Jiang et al., J. Biol.Chem. 271(30):1777178 (1996) showed that HIF-1α truncated at amino acid390 lost transactivation activity but retained the ability to bind DNAand showed high levels of protein under both normoxic and hypoxicconditions. This result demonstrated that the transactivation domain andthe region conferring instability with normoxia reside in the C-terminalhalf of the protein. Pugh et al., J. Biol. Chem. 272(17):11205 14 (1997)have further localized the regions involved to two areas, amino acids549-582 and 775-826.

An approximately 200-amino acid domain, referred to as the“oxygen-dependent degradation domain” (ODD), mediates the degradation ofHIF-1α (Huang, L., J. Gu, M. Schau, and H. Bunn. 1998. Proc. Natl. Acad.Sci. U.S.A. 95: 7987-92). Deletion of the ODD (HIF-1□□ODD) results in aconstitutively active HIF-1α regardless of oxygen concentration (Huang,L., J. Gu, M. Schau, and H. Bunn. 1998. Proc. Natl. Acad. Sci. U.S.A.95: 7987-92; U.S. Pat. No. 6,124,131).

In one embodiment, this invention provides nucleic acid moleculesencoding biologically active chimeric transactivator proteins comprisinga domain of the HIF-1α protein sufficient for DNA binding anddimerization with HIF-1β (ARNT) and a protein domain capable oftranscriptional activation.

In mice, two HIF-1α transcripts (I.1 and I.2) are produced fromdifferent promoters, as opposed to alternate splicing (Wenger, R. H., etal., Eur. J. Biochem. 246:155-65 (1997). These transcripts are bothefficiently translated independent of oxygen, but differ in thattranscript I.1 encodes a protein lacking the first 12 amino-terminalamino acids and is expressed in a tissue-restricted manner, while I.2 isubiquitously expressed and encodes a full-length protein. In spite ofthese differences, no specificity in DNA binding or transactivationactivity has been observed (Wenger, R. H., et al., Blood 91:3471-80(1998); Gorlach, A., et al., Biochem. Biophys. Acta 1493:125-134(2000)). Several splice variants of HIF-1α have also been observed inhumans. For example, a HIF-1α splice variant that lacks exon 14 has beenfound to be present in skin and several cell lines (Gothie, E., et al.,J. Biol. Chem. 275:6922-27 (2000)). This leads to a frame shift andencodes a shorter protein (736 amino acids) which, although stillhypoxically inducible, lacks a carboxy-terminal TAD (C-TAD) andtherefore is less active than wild-type HIF-1α (Gothie, E., et al., J.Biol. Chem. 275:6922-27 (2000)). A dominant-negative isoform lackingexons 11 and 12 has also been identified, which encodes a protein thatis 516 amino acids long, stable in normoxia and displays notransactivation (Chun, Y. S., et al., Biochem. J. 362:71-79 (2002)). Inaddition, a zinc-induced splice variant lacking exon 12 also acts as adominant negative, inhibiting HIF activity by binding to ARNT andpreventing its nuclear accumulation (Chun, Y. S., et al., Biochem.Biophys. Res. Commun. 268:652-56 (2000)).

Representative sequences of human HIF-1α include, for example, GenbankAccession Nos. NM_(—)001530 (transcript variant 1) and NM_(—)181054(transcript variant 2). Representative sequences of the human HIF-1βsubunit include, for example, Genbank Accession Nos. NM_(—)001668 (ARNTtranscript variant 1), NM_(—)178426 (ARNT transcript variant 2) andNM_(—)178427 (ARNT transcript variant 3).

A closely related protein, HIF-2α (also termed endothelial PAS (EPAS),HIF-related factor (HRF) and member of PAS superfamily 2 (MOP2)) wasidentified shortly after HIF-1α was cloned (Tian, H., et al., Genes Dev.11:72-82 (1997); Ema, M., et al., Proc. Natl. Acad. Sci. USA 94:4273-78(1997); Flamme, I., et al., Mech. Dev. 63:51-60 (1997); Hogenesch, J.B., et al., Proc. Natl. Acad. Sci. USA 95:5474-79 (1998)). HIF-2α shares48% amino acid identity with HIF-1α and lesser similarity with othermembers of bHLH/PAS domain family of transcription factors(representative HIF-2α human sequences are GenBank Accession Nos.NM_(—)001430 and U81984; a representative HIF-2α mouse sequence isGenBank Accession No. U81983). Like HIF-1□, HIF-2α was found toheterodimerize with ARNT and bind HREs (Tian, H., et al., Genes Dev.11:72-82 (1997); Ema, M., et al., Proc. Natl. Acad. Sci. USA 94:4273-78(1997)). Deletion analysis has demonstrated that both HIF-1α and HIF-2αshare a common functional domain architecture. Specifically, in additionto the amino-terminal bHLH and PAS domains, HIF-1α and HIF-2α possesstwo transactivation domains (TADs) separated by a region termed theinhibitory domain (ID), which is responsible for normoxic repression ofTAD activity. Overlapping the amino-terminal TAD (N-TAD) is anoxygen-dependent degradation domain (ODDD), which confers normoxicstability to the HIF□-proteins (Bracken, C. P., et al., CMLS. Cell. Mol.Life Sci. 60:1376-93 (2003)).

Human and murine HIF-2α share extensive primary amino acid sequenceidentity with HIF-1α (48%). Sequence conservation between the twoproteins is highest in the bHLH (85%), PAS-A (68%), and PAS-B (73%)regions. A second region of sequence identity occurs at the extreme Ctermini of the HIF-1α and HIF-2α proteins. This conserved region inmHIF-1α has been shown to contain a hypoxia response domain (Li et al.,J. Biol. Chem. 271(35):21262-67 (1996)). The high degree of sequencesimilarity between HIF-1α and HIF-2α suggests that they share commonphysiological function(s). Hypoxic conditions stimulate the ability ofHIF-1α to transactivate target genes containing the HRE core sequence.The activity of HIF-2α is also enhanced in cells grown under hypoxicconditions.

RNA expression patterns have revealed that both HIF-1α and HIF-2α arelargely ubiquitously expressed in human and mouse tissues in anoxygen-independent manner (Tian, H., et al., Genes Dev. 11:72-82 (1997);Ema, M., et al., Proc. Natl. Acad. Sci. USA 94:4273-78 (1997); Flamme,I., et al., Mech. Dev. 63:51-60 (1997); Wenger, R. H., et al., KidneyInt. 51:560-63 (1997); Wiesener, M. S., et al., Blood 92:2260-68(1998)). Cell-type-specific expression pattern analysis has revealed,however, that in contrast to ubiquitous HIF-1□, HIF-2α mRNA ispredominantly expressed in specific cell types, such as endothelial,epithelial, neuronal, fibroblasts and macrophage cells (Bracken, C. P.,et al., CMLS. Cell. Mol. Life Sci. 60:1376-93 (2003)).

A third HIFα gene has also been discovered and been termed HIF-3□. LikeHIF-1α and HIF-2□, HIF-3α is expressed by a variety of tissues,dimerizes with ARNT, binds to HRE DNA sequences and upregulates reporterexpression in a hypoxia-inducible and ARNT-dependent manner (Gu, Y. Z.,et al., Gene Expr. 7:205-13 (1998)). A splice variant of HIF-3□, termedinhibitory PAS (IPAS), has been identified. IPAS appears to lackendogenous transactivation activity but acts as a dominant-negativeregulator of HIF, interacting with the amino-terminal region of HIF-1αand preventing DNA binding. Representative sequences of human HIF-3α areGenbank Accession Nos. NM_(—)152794 (HIF-3α transcript variant 1),NM_(—)152794 (HIF-3α transcript variant 2) and NM_(—)022462 (HIF-3αtranscript variant 3).

As described herein and is apparent to those of skill in the art,sequences of HIF-1□, HIF-2α and/or HIF-3□, including sequences of anyknown or discovered splice variants, can be used in the methods of theinvention.

Much has been discovered about the regulation of HIF-□. Normoxicturnover of HIF-α is very rapid and results in essentially no detectableHIF-α protein under normoxic conditions (Wang, G. L., et al., Proc.Natl. Acad. Sci. USA 92:5510-14 (1995); Yu, A. Y., et al., Am. J.Physiol. 275:L818-L826 (1998); Huang, L. E., et al., Proc. Natl. Acad.Sci. USA 95:7987-92 (1998)). This normoxic stability is controlled bythe central 200-amino acid ODDD that overlaps the N-TAD (Huang, L. E.,et al., Proc. Natl. Acad. Sci. USA 95:7987-92 (1998)). The rapidaccumulation of HIF-1α and HIF-2α that occurs in hypoxia is mediated byincreased protein stability. In contrast, oxygen tension does not have amajor effect on HIF-A transcription or translation (Wenger, R. H., etal., Kidney Int. 51:560-63 (1997); Huang, L. E., et al., Proc. Natl.Acad. Sci. USA 95:7987-92 (1998)); Huang, L. E., et al., J. Biol. Chem.271:32253-59 (1996); Powell, J. D., et al., Biol. Reprod. 67:995-1002(2002); Kallio, P. J., et al., Proc. Natl. Acad. Sci. USA 94:5667-72(1997)). Similarly, oxygen does not significantly affect ARNT mRNA orprotein levels, which are constitutively expressed (Huang, L. E., etal., Proc. Natl. Acad. Sci. USA 95:7987-92 (1998)); Huang, L. E., etal., J. Biol. Chem. 271:32253-59 (1996); Kallio, P. J., et al., Proc.Natl. Acad. Sci. USA 94:5667-72 (1997)).

Normoxic instability of HIF-α is mediated by polyubiquitylation andsubsequent degradation by the proteasome. This has been demonstratedusing proteasomal inhibitors or mutation of the E1 ubiquitin activatingenzyme (Huang, L. E., et al., Proc. Natl. Acad. Sci. USA 95:7987-92(1998); Kallio, P. J., et al., J. Biol. Chem. 274:6519-25 (1999)). Thus,HIF-α is polyubiquitylated under normoxia with the level ofubiquitylation decreasing in hypoxia (Huang, L. E., et al., Proc. Natl.Acad. Sci. USA 95:7987-92 (1998); Kallio, P. J., et al., J. Biol. Chem.274:6519-25 (1999); Sutter, C. H., et al., Proc. Natl. Acad. Sci. USA97:4748-53 (2000)). In addition, HIF-1α has been shown to physicallyinteract with the 20α proteasomal subunit PSMA7 (Cho, S., et al., FEBSLett. 498:62-66 (2001)).

The von-Hippel-Lindau (VHL) tumor suppressor protein is a component ofan E3 ubiquitin-protein ligase complex containing elongins B and C, Cul2and Rbx1, and it is this capacity by which VHL mediates the proteasomaldegradation of HIF-1α and HIF-2α (Lisztwan, J., et al., Genes Dev.13:1822-33 (1999)). Support is provided by the finding that undernormoxic conditions, HIF-1α is stable in VHL-deficient cells, however,normoxic protein stability is restored upon VHL transfection (Maxwell,P. H., et al., Nature 399:271-75 (1999); Cockman, M. E., et al., J.Biol. Chem. 275:25733-741 (2000)). VHL is able to exert this effect bybinding to amino acids 517-571 or 380-417 of HIF-1α in normoxia (aminoacids 517-534 and 383-418 in HIF-2□) via its β domain, while the αdomain binds elongins. Ubiquitin is then transferred to residues of HIF,marking the protein for proteasomal degradation (Cockman, M. E., et al.,J. Biol. Chem. 275:25733-741 (2000); Ohh, M., et al., Nat. Cell Biol.2:423-27 (2000)); Tanimoto, K., et al., EMBO J. 19:4298-4309 (2000);Masson, N., et al., EMBO J. 20:5197-5206 (2001); Srinivas, V., et al.,Biochem. Biophys. Res. Commun. 260:557-61 (1999)).

It has been discovered that the binding of VHL to HIF in normoxia, andthus the major mechanism by which HIF protein instability is conferred,is mediated by the irreversible hydroxylation of two proline residues(P402 and P564 in HIF-1□, P405 and P530 in HIF-2□) (Jaakkola, P., etal., Science 292:468-72 (2001); Ivan, M., et al., Science 292:464-68(2001); Yu, F., et al., Proc. Natl. Acad. Sci. USA 98:9630-35 (2001));Chan, D. A., et al., J. Biol. Chem. 277:40112-17 (2002)). These residuesare hydroxylated only in normoxia, enabling the high-affinity binding ofVHL to HIF (Min, J. H., et al., Science 296:1886-89 (2002)). Theidentification of eg19, a HIF prolyl-hydroxylase in Caenorhabditiselegans, enabled the cloning of three mammalian homologs designatedprolyl-hydroxylase domain containing (PHDs) 1, 2 and 3, or HIFprolyl-hydroxylases (HPHs 3, 2 and 1, respectively (Bruick, R. K., etal., Science 294:1337-40 (2001); Epstein, A. C., et al., Cell 107:43-54(2001); Ivan, M., et al., Proc. Natl. Acad. Sci. USA 99:13459-464(2002); Lieb, M. E., et al., Biochem. Cell. Biol. 80:421-426 (2002);Huang, J., et al., J. Biol. Chem. 277:39792-800 (2002)). A widelyexpressed fourth PHD/HPH has also been identified (Oehme, F., et al.,Biochem. Biophys. Res. Commun. 296(2):343-49 (2002)).

The PHD/HPHs are 2-oxogluterate-dependent enzymes that require oxygen(O₂) for hydroxylation. They contain iron bound to two histidine and oneaspartic acid residue, which, when maintained in its ferrous state byascorbate, binds dioxygen. One oxygen is transferred to the targetproline residue of HIF; the second reacts with 2-oxogluterate to producesuccinate and carbon dioxide. Thus, the absence of oxygen leads to noenzyme activity, nonmodification of HIF proline residues and no VHL/HIFbinding, resulting in stabilized HIF-α protein.

Therefore, it is likely that PHD/HPHs function as a direct oxygen sensorin cells that directly modulate HIF in response to physiological oxygenconcentration (Bracken, C. P., et al., CMLS. Cell. Mol. Life Sci.60:1376-93 (2003)).

In one embodiment, the nucleic acid molecules encoding the chimerictransactivator proteins comprise a domain of a non-mammalianhypoxia-inducible factor protein. As will be recognized by the skilledartisan, the adaptive response to hypoxia is likely to have been highlyconserved throughout evolution. Accordingly, hypoxia-inducible factorproteins would be expected to occur in a wide variety of speciesincluding non-mammalian vertebrates and non-vertebrates, such asinsects. See, for example, Bacon et al., Biochem. Biophys. Res. Comm.,249:811-816 (1998), which reports the functional similarity between theSima basic-helix-loop-helix PAS protein from Drosophila and themammalian HIF-1α protein.

Nucleic acid and amino acid sequences for non-mammalianhypoxia-inducible factor proteins may be obtained by the skilled artisanby a variety of techniques, for example, by cross-hybridization oramplification using all or a portion of the sequences referred toherein. Once the sequence encoding a candidate hypoxia-inducible factorprotein has been determined, the localization of portions of the proteinsufficient to bind to HREs and dimerize with HIF-1β may be determinedusing, e.g., the same types of techniques used to determine the locationof those domains within the human HIF-1α protein. Relevant domains ofnon-mammalian hypoxia-inducible factor proteins useful in thecompositions and methods of this invention may also be producedsynthetically or by site-directed manipulations of the DNA encodingknown mammalian hypoxia-inducible factor proteins. It is also expectedthat the sequence motifs in common among various mammalian andnon-mammalian hypoxia-inducible factor proteins will suggest consensussequences that, while perhaps not occurring naturally in any species,would nevertheless produce domains useful in the methods andcompositions of this invention. All that is required in order tosubstitute such non-mammalian hypoxia-inducible factor protein domainsfor the human HIF-1α protein domains exemplified herein is that they beable to bind to HREs and dimerize with HIF-1β (ARNT).

For example, although the HIF-1

subunit is unstable during normoxic conditions, overexpression of thissubunit in cultured cells under normal oxygen levels is capable ofinducing expression of genes normally induced by hypoxia. An alternativestrategy would be to modify the HIF-1

subunit such that it no longer is destabilized by normoxic conditionsand would therefore be more potent under a range of oxygen conditions.

Replacement of the C terminal (or transactivation) region of thehypoxia-inducible factor protein with a strong transactivation domainfrom a transcriptional activator protein such as, for example, HerpesSimplex Virus (HSV) VP16, NF□B or yeast transcription factors GAL4 andGCN4, is designed to stabilize the protein under normoxic conditions andprovide strong, constitutive, transcriptional activation.

To stabilize the hypoxia-inducible factor protein under normoxicconditions and to provide strong, constitutive transcriptionalactivation, a hybrid/chimeric fusion protein consisting of theDNA-binding and dimerization domains from HIF-1

and the transactivation domain from Herpes Simplex Virus (HSV) VP16protein was constructed. Administration of this hybrid/chimera to thecells of a subject via gene therapy induces the expression of genesnormally up-regulated in response to hypoxia (i.e., VEGF and the like).A constitutively stable hybrid HIF-1α has been shown to be effective fortreating ischemic patients (U.S. Pat. Nos. 6,432,927 and 7,053,062, bothof which are incorporated by reference herein in their entirety).

Thus, as described and exemplified herein, administration of a nucleicacid molecule encoding a biologically active chimeric transactivatorprotein comprising the DNA-binding domain of a hypoxia-inducible factorprotein (e.g., HIF-1□) and a protein domain capable of transcriptionalactivation (e.g., a transcriptional activation domain from HSV VP16, atranscriptional activation domain from NF□B) can treat neurodegenerativemotor disorders in a patient in need thereof. In one embodiment, theDNA-binding domain is a DNA-binding domain of HIF-1α and the proteindomain capable of transcriptional activation is a transcriptionalactivation domain of HSV VP 16. A representative cDNA nucleic acidsequence of such a HIF1□/VP16 construct, which contains the DNA-bindingdomain and HIF-1β dimerization domain of HIF-1α and the transcriptionalactivation domain of HSV VP16, is the following:

(SEQ ID NO: ) ATGGAGGGCGCCGGCGGCGCGAACGACAAGAAAAAGATAAGTTCTGAACGTCGAAAAGAAAAGTCTCGAGATGCAGCCAGATCTCGGCGAAGTAAAGAATCTGAAGTTTTTTATGAGCTTGCTCATCAGTTGCCACTTCCACATAATGTGAGTTCGCATCTTGATAAGGCCTCTGTGATGAGGCTTACCATCAGCTATTTGCGTGTGAGGAAACTTCTGGATGCTGGTGATTTGGATATTGAAGATGACATGAAAGCACAGATGAATTGCTTTTATTTGAAAGCCTTGGATGGTTTTGTTATGGTTCTCACAGATGATGGTGACATGATTTACATTTCTGATAATGTGAACAAATACATGGGATTAACTCAGTTTGAACTAACTGGACACAGTGTGTTTGATTTTACTCATCCATGTGACCATGAGGAAATGAGAGAAATGCTTACACACAGAAATGGCCTTGTGAAAAAGGGTAAAGAACAAAACACACAGCGAAGCTTTTTTCTCAGAATGAAGTGTACCCTAACTAGCCGAGGAAGAACTATGAACATAAAGTCTGCAACATGGAAGGTATTGCACTGCACAGGCCACATTCACGTATATGATACCAACAGTAACCAACCTCAGTGTGGGTATAAGAAACCACCTATGACCTGCTTGGTGCTGATTTGTGAACCCATTCCTCACCCATCAAATATTGAAATTCCTTTAGATAGCAAGACTTTCCTCAGTCGACACAGCCTGGATATGAAATTTTCTTATTGTGATGAAAGAATTACCGAATTGATGGGATATGAGCCAGAAGAACTTTTAGGCCGCTCAATTTATGAATATTATCATGCTTTGGACTCTGATCATCTGACCAAAACTCATCATGATATGTTTACTAAAGGACAAGTCACCACAGGACAGTACAGGATGCTTGCCAAAAGAGGTGGATATGTCTGGGTTGAAACTCAAGCAACTGTCACATATAACACCAAGAATTCTCAACCACAGTGCATTGTATGTGTGAATTACGTTGTGAGTGGTATTATTCAGCACGACTTGATTTTCTCCCTTCAACAAACAGAATGTGTCCTTAAACCGGTTGAATCTTCAGATATGAAAATGACTCAGCTATTCACCAAAGTTGAATCAGAAGATACAAGTAGCCTCTTTGACAAACTTAAGCCGGATTCCCGGGGATCTGGGCCCCCCCGACCGATGTCAGCCTGGGGGACGAGCTCCACTTAGACGGCGAGGACGTGGCGATGGCGCATGCCGACGCGCTAGACGATTTCGATCTGGACATGTTGGGGGACGGGGATTCCCCGGGGCCGGGATTTACCCCCCACGACTCCGCCCCCTACGGCGCTCTGGATATGGCCGACTTCGAGTTTGAGCAGATGTTTACCGATGCCCTTGGAATTGACGAGTACGGTGGGTAG.

In this representative nucleic acid sequence, the sequence of the HIF-1αDNA-binding and HIF-1β dimerization domains is the following:

(SEQ ID NO: ) ATGGAGGGCGCCGGCGGCGCGAACGACAAGAAAAAGATAAGTTCTGAACGTCGAAAAGAAAAGTCTCGAGATGCAGCCAGATCTCGGCGAAGTAAAGAATCTGAAGTTTTTTATGAGCTTGCTCATCAGTTGCCACTTCCACATAATGTGAGTTCGCATCTTGATAAGGCCTCTGTGATGAGGCTTACCATCAGCTATTTGCGTGTGAGGAAACTTCTGGATGCTGGTGATTTGGATATTGAAGATGACATGAAAGCACAGATGAATTGCTTTTATTTGAAAGCCTTGGATGGTTTTGTTATGGTTCTCACAGATGATGGTGACATGATTTACATTTCTGATAATGTGAACAAATACATGGGATTAACTCAGTTTGAACTAACTGGACACAGTGTGTTTGATTTTACTCATCCATGTGACCATGAGGAAATGAGAGAAATGCTTACACACAGAAATGGCCTTGTGAAAAAGGGTAAAGAACAAAACACACAGCGAAGCTTTTTTCTCAGAATGAAGTGTACCCTAACTAGCCGAGGAAGAACTATGAACATAAAGTCTGCAACATGGAAGGTATTGCACTGCACAGGCCACATTCACGTATATGATACCAACAGTAACCAACCTCAGTGTGGGTATAAGAAACCACCTATGACCTGCTTGGTGCTGATTTGTGAACCCATTCCTCACCCATCAAATATTGAAATTCCTTTAGATAGCAAGACTTTCCTCAGTCGACACAGCCTGGATATGAAATTTTCTTATTGTGATGAAAGAATTACCGAATTGATGGGATATGAGCCAGAAGAACTTTTAGGCCGCTCAATTTATGAATATTATCATGCTTTGGACTCTGATCATCTGACCAAAACTCATCATGATATGTTTACTAAAGGACAAGTCACCACAGGACAGTACAGGATGCTTGCCAAAAGAGGTGGATATGTCTGGGTTGAAACTCAAGCAACTGTCACATATAACACCAAGAATTCTCAACCACAGTGCATTGTATGTGTGAATTACGTTGTGAGTGGTATTATTCAGCACGACTTGATTTTCTCCCTTCAACAAAACAGAATGTGTCCTTAAACCGGTTGAATCTTCAGATATGAAAATGACTCAGCTATTCACCAAAGTTGAATCAGAAGATACAAGTAGCCTCTTTGACAAACTTAAG.

In this representative sequence, the sequence of the transcriptionalactivation domain of HSV VP16 is the following:

(SEQ ID NO: ) CCGGAATTCCCGGGGATCTGGGCCCCCCCGACCGATGTCAGCCTGGGGGACGAGCTCCACTTAGACGGCGAGGACGTGGCGATGGCGCATGCCGACGCGCTAGACGATTTCGATCTGGACATGTTGGGGGACGGGGATTCCCCGGGGCCGGGATTTACCCCCCACGACTCCGCCCCCTACGGCGCTCTGGATATGGCCGACTTCGAGTTTGAGCAGACCGGAATTCCCGGGGATCTGGGCCCCCCCGACCGATGTCAGCCTGGGGGACGAGCTCCACTTAGACGGCGAGGACGTGGCGATGGCGCATGCCGACGCGCTAGACGATTTCGATCTGGACATGTTGGGGGACGGGGATTCCCCGGGGCCGGGATTTACCCCCCACGACTCCGCCCCCTACGGCGCTCTGGATATGGCCGACTTCGAGTTTGAGCAGATGTTTACCGATGCCCTTGGAATTGACGAGTACGGTGGGTAG.

The invention encompasses other nucleic acids that encode biologicallyactive chimeric transactivator proteins, for example, a proteincomprising the DNA-binding and dimerization domains of HIF-1

and the transactivation domain from an NF□B protein (e.g., a human NF□Bprotein).

Eukaryotic transcription factors are often composed of separate andindependent DNA-binding and transcriptional activator domains (Mitchelland Tjian, Science 245:371-378 (1989)). The independence of the domainshas allowed for the creation of functional fusion proteins consisting ofthe DNA-binding and activating domains of heterologous proteins.Chimeric eukaryotic regulatory proteins, consisting of the lexaDNA-binding protein and the activation domain of the yeast transcriptionfactor, GAL4, were constructed by Brent and Ptashne (Nature 312:612-615(1985)). The use of fusion proteins has identified several types ofprotein domains which act as transcriptional activators. These domainshave little amino acid similarity but often are characterized as beingeither highly acidic (as in the case of GAL4 and GNC4), glutamine-rich(as in the case of Spl), or proline-rich (as in the case of NF1, Ma andPtashne, Cell 51:113-119 (1987); Courey and Tjian (1988); Mermod et al.,Cell 58:741-753 (1989)).

One of the most efficient activator domains known is contained in thecarboxyl-terminal 100 amino acids of the Herpes Simplex Virus (HSV)virion protein 16 (VP16) (Sadowski et al., Nature 335:563-564 (1988);Triezenberg et al., Genes & Dev. 2:718-729 (1988)). VP16, also known asVmw65 or alpha-gene trans-inducing factor, is a structural protein ofHSV which activates transcription of the immediate early promoters ofthe virus, including those for ICPO and ICP4 (Campbell et al., J. Mol.Biol. 180:1-19 (1984); Kristie and Roizman, Proc. Natl. Acad. Sci., USA81:4065-4069 (1984); Pellet et al., Proc. Natl. Acad. Sci., USA82:5870-5874 (1985)). Although VP16 specifically activates promoterscontaining the so called TAATGARAT element, the specificity is endowedby a cellular DNA-binding protein(s) that is complexed with the aminoterminal domains(s) of VP16 (McKnight et al., Proc. Natl. Acad. Sci.,USA 84:7061-7065 (1987); Preston et al., Cell 52:425-434 (1988)).

The present invention provides nucleic acids encoding hybrid/chimerictransactivating proteins comprising a functional portion of aDNA-binding protein and a functional portion of a transcriptionalactivator protein. Such hybrid/chimeric transactivating proteins offer avariety of advantages, including specific activation of expression ofhypoxia-inducible genes containing hypoxia responsive elements (HREs),thereby achieving exceptionally high levels of gene expression. Nucleicacids encoding such hybrid/chimeric transactivating proteins are capableof functioning in vertebrate cells and may encode naturally-occurringtranscriptional transactivating proteins or domains of proteins (e.g.,naturally-occurring transcriptional transactivating proteins or domainsfrom eukaryotic cells including vertebrate cells), viral transactivatingproteins or domains or any synthetic amino acid sequence that is able tostimulate transcription from a vertebrate promoter. Examples of suchtransactivating proteins include, but are not limited to, the lymphoidspecific transcription factor identified by Muller et al. (Nature336:544-551 (1988)), the fos protein (Lucibello et al., Oncogene 3:43-52(1988)); v-jun protein (Bos et al., Cell 52:705-712 (1988)); factor EF-C(Ostapchuk et al., Mol. Cell. Biol. 9:2787-2797 (1989)); HIV-1 tatprotein (Arya et al., Science 229:69-73 (1985)), the papillomavirus E2protein (Lambert et al., J. Virol. 63:3151-3154 (1989)) the adenovirusEIA protein (reviewed in Flint and Shenk, Ann. Rev. Genet. (1989), heatshock factors (HSF1 and HSF2) (Rabindran, et al., PNAS 88:6906-6910(1991)); the p53 protein (Levine, Cell 88:323-331 (1997), Ko and Prives,Genes Dev. 10:1054-1072 (1996)); Spl (Kadonaga, et al. Cell 51:1079-1090(1987)); AP1 (Lee, et al., Nature 325:368-372 (1987)); CTF/NF1 (Mermod,et al., Cell 58: 741-753 (1989)), E2F1 (Neuman, et al., Gene 173:163-169 (1996)); HAP1 (Pfeifer, et al., Cell 56: 291-301 (1989)); HAP2(Pinkham, et al., Mol. Cell. Biol. 7:578-585 (1987)); MCM1 (Passmore, etal., J. Mol. Biol. 204:593-606 (1988); PHO2 (Sengstag, and Hinnen, NAR15:233-246 (1987)); and GAL11 (Suzuki et al., Mol. Cell. Biol.8:4991-4999 (1988)). In particular embodiments of the invention, thetransactivating protein is Herpes simplex virus VP 16 (Sadowski et al.,Nature 335:563-564 (1988); Triezenberg et al., Genes and Dev. 2:718-729(1988)), NF.kappa.B ((Schmitz and Baeuerle, EMBO J. 10:3805-3817 (1991);Schmitz, et al., J. Biol. Chem. 269:25613-25620 (1994); and Schmitz, etal., J. Biol. Chem. 270:15576-15584 (1995)), and yeast activators GAL4and GCN4.

Of course, the skilled artisan will understand that transcriptionalactivation domains useful in the compositions and methods of thisinvention may also be synthetic, i.e., based on a sequence that is notcontained within a known, naturally-occurring protein. See, for example,Pollock and Gilman, PNAS 94:13388-13389 (1997), which teaches thattranscriptional activation is an inherently flexible process in whichthere is little, if any, requirement for specific structures orstereospecific protein contacts. It also reviews the variety ofdifferent molecules that can function as transcriptional activators,including short peptide motifs (as small as eight amino acids), simpleamphipathic helices and even mutagenized domains of proteins unrelatedto transcriptional activation.

According to the invention, nucleic acid sequences encoding aDNA-binding domain and a transactivating domain are combined so as topreserve the respective binding and transactivating properties of eachof the domains. In various embodiments of the invention, the nucleicacid encoding the transactivating protein, or a portion thereof capableof activating transcription, may be inserted into nucleic acid at alocus which does not completely disrupt the function of the encodedDNA-binding domain. Regions of hypoxia-inducible factor proteins thatare not required for DNA-binding and dimerization functions and regionsof proteins that are not required for transcriptional transactivatingfunction are known and/or may be identified by methods known in the art,including, e.g., analysis of mapped mutations as well as identificationof regions lacking mapped mutations, which are presumably less sensitiveto mutation than other, more functionally relevant portions of themolecule. The appropriate recombinant constructs may be produced usingstandard techniques in molecular biology, including those set forth inManiatis (Molecular Cloning: A Laboratory Manual (Cold Spring Harbor,N.Y., Cold Spring Harbor Laboratory (1989)).

The recombinant DNA construct encoding the chimeric transactivatorprotein may be placed under the control of (i.e., operatively linked to)a suitable promoter and/or other expression control sequence. It may bedesirable for the transactivator protein to be placed under the controlof a constitutively active promoter sequence, although thetransactivator protein may also be placed under the control of aninducible promoter, such as the metallothionine promoter (Brinster etal., Nature 296:39-42 (1982)) or a tissue-specific promoter. Promotersequences that can be used according to the invention include, but arenot limited to, the SV40 early promoter region (Benoist and Chambon,Nature 290:304-310 (1981)), the promoter contained in the long terminalrepeat of Rous sarcoma virus (Yamamoto, et al., Cell 22:787-797 (1980)),the herpes thymidine kinase promoter (Wagner et al., Proc. Natl. Acad.Sci., U.S.A. 78:144-1445 (1981)), the human cytomegalovirus (CMV)immediate early promoter/enhancer (Boshart et al., Cell 41:521-530(1985)).

In one embodiment of the invention, the chimeric transactivator proteinis encoded by pcDNA3/HIF/VP16/Afl2. In another embodiment, the chimerictransactivator protein is encoded by pcDNA3/HIF/VP16/RI, which isidentical to pcDNA3/HIF/VP16/Afl2 except that the VP 16 segment isinserted after codon 530 of the HIF-1

coding region.

According to the invention, the nucleic acids encoding hybrid/chimerictransactivator proteins may be utilized to specifically regulate theexpression of genes containing hypoxia responsive elements (HREs). TheseHREs correspond to a nucleic acid sequence recognized and bound by theDNA-binding protein used as the backbone of the chimeric transactivatorprotein.

In general, the nucleic acids encoding chimeric transactivator proteinsmay be used to selectively control the expression of genes of interest.For example, and not by way of limitation, chimeric transactivatorproteins may be placed under control of a constitutive promoter and maybe used to constitutively increase the expression of a gene of interestassociated with hypoxia responsive elements (HREs), for example, when itis desirable to produce a particular gene product in quantity in a cellculture or in a transgenic animal. Alternatively, the transactivatorprotein may be placed under the control of a tissue-specific promoter sothat the gene of interest is expressed in a particular tissue. Inalternative embodiments of the invention, the chimeric transactivatorfunction is inducible, so that the expression of a gene of interest, viahypoxia responsive elements (HREs), may be selectively increased ordecreased. For reviews of conditional and inducible transgeneexpression, see Fishman, Circ. Res., 82:837-844 (1998) and Fishman,Trends Cardiovasc. Med., 5:211-217 (1995).

For additional information on HIF1-alpha constructs see, for example,U.S. Pat. No. 6,432,947.

Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerativecondition involving the loss of large motor neurons in the brain andspinal cord. It is characterized by progressive weakness, atrophy andspasticity, leading to paralysis and respiratory failure within fiveyears of onset. Familial ALS accounts for 10% of all ALS cases;approximately 25% of these cases are due to mutations in the Cu/Znsuperoxide dismutase gene (SOD1) [1]. To date 109 different mutationshave been identified in the SOD 1 gene; these span all five exons [2].Besides very rare mutations in genes for heavy neurofilament chain(NFH), dynactin, vesicular binding protein 1 gene and the ALSIN gene,SOD1 is the only major ALS susceptibility locus identified. SOD1 is amainly cytoplasmic enzyme that catalyzes the breakdown of superoxideions to oxygen and hydrogen peroxide, which in turn is degraded byglutathione peroxidase or catalase to form water. Several lines ofevidence argue that the mutant SOD1 protein is neurotoxic through anacquired, adverse function that entails both oxidative pathology andprotein aggregation, with secondary disturbances of glutamatemetabolism, mitochondrial function, axonal transport and calciumhomeostasis [3]. That mutant SOD1 is toxic is strongly supported by theobservation that transgenic expression of high levels of mutant SOD1protein in mice produces a motor neuron disease phenotype, with age ofonset and disease duration dependent on copy number [4].

To date, few therapeutic interventions have altered the motor neuronphenotype in the transgenic ALS mice. Although more than 100 smallmolecules have been tested to date, few have had even a marginal benefit(e.g. riluzole [5], celecoxib [6], arimoclomol [7]). By contrast, someforms of protein therapy have been beneficial. Thus, significantimprovement in survival was produced by administering insulin-likegrowth factor 1 (IGF-1) either transgenically [8] or throughAAV2-delivery via IM injection and subsequent retrograde axonaltransport to motor nerves [9]. Two other proteins that have showntherapeutic promise as neuroprotective agents are erythropoietin [10]and vascular endothelial factor (VEGF) [11, 12]. The latter is ofparticular interest because genetic analysis has implicated hypomorphicvariants in the VEGF gene as a risk factor for ALS [13]. Moreover, micethat lack hypoxia-responsive promoter elements develop a slowlyprogressive motor neuron disease [14]. Subsequently, it was documentedthat lentiviral delivery of VEGF to the spinal cord of ALS mice delaysdeath [15]. Two independent investigators have reported that infusion ofVEGF into the cerebrospinal fluid in ALS mice [16] and rats [17] alsoslow the disease course.

For this reason, one embodiment of the instant invention is a methodthat increases the levels of the VEGF family of neurotrophic proteinsand/or EPO comprising injecting a neurotrophic vector encoding forHIF-1α into the spinal cord region of a subject with ALS or anothermotor neuron disorder. The method may increases more than one suchneurotrophic protein. Without being limited as to theory, delivery of atransgene encoding for HIF-1α will increase the expression of varioustargets genes of HIF-1 thus providing a benefit to motor neurons insites of HIF-1α expression.

Without being limited as to theory, direct spinal cord injection of aneurotrophic vector also provides an advantage for the delivery oftherapeutic molecules, such as HIF-1α, that function more efficientlywhen expressed directly in spinal cord cells. For example, neurotrophicvectors encoding for molecules such as short interfering RNA (siRNA) maybe delivered to spinal cord cells via direct injection of the spinalcord. siRNA delivered in this manner may directly intracellularly exerteffects on transduced spinal cord cells.

In addition, certain genetic motor neuron disorders, such as SMA, may betreated by direct injection of the spinal cord with a neurotrophicvector encoding for a therapeutic gene. The instant method of directspinal cord injection provides a means to deliver recombinant virusdirectly to cells in the spinal cord area.

Suitable neurotrophic viral vectors for the practice of this inventioninclude, but are not limited to adeno-associated viral vectors (AAV),herpes simplex viral vectors (U.S. Pat. No. 5,672,344) and lentiviralvectors.

In the methods of the invention, AAV of any serotype or pseudotype canbe used. The serotype of the viral vector used in certain embodiments ofthe invention is selected from the group consisting from AAV1, AAV2,AAV3, AAV4, AAV5, AAV6, AAV7, and AAV8 (see, e.g., Gao et al. (2002)PNAS, 99:11854-11859; and Viral Vectors for Gene Therapy Methods andProtocols, ed. Machida, Humana Press, 2003). Other serotype besidesthose listed herein can be used. Furthermore, pseudotyped AAV vectorsmay also be utilized in the methods described herein. Pseudotyped AAVvectors are those which contain the inverted terminal repeats (ITRs) ofone AAV serotype and the capsid of a second AAV serotype; for example,an AAV vector that contains the AAV2 capsid and the AAV1 ITRs (i.e.AAV1/2) or an AAV vector that contains the AAV5 capsid and the AAV2 ITRs(i.e. AAV2/5).

AAV vectors are derived from single-stranded (ss) DNA parvoviruses thatare nonpathogenic for mammals (reviewed in Muzyscka (1992) Curr. Top.Microb. Immunol., 158:97-129). Briefly, AAV-based vectors have the repand cap viral genes that account for 96% of the viral genome removed,leaving the two flanking 145-basepair (bp) inverted terminal repeats(ITRs), which are used to initiate viral DNA replication, packaging andintegration. In the absence of helper virus, wild-type AAV integratesinto the human host-cell genome with preferential site-specificity atchromosome 19q 13.3 or it may be maintained episomally. A single AAVparticle can accommodate up to 5 kb of ssDNA, therefore leaving about4.5 kb for a transgene and regulatory elements, which is typicallysufficient. However, trans-splicing systems as described, for example,in U.S. Pat. No. 6,544,785, may nearly double this limit.

In an illustrative embodiment, AAV is AAV7 or AAV8. Adeno-associatedvirus of many serotypes, especially AAV2, have been extensively studiedand characterized as gene therapy vectors. Those skilled in the art willbe familiar with the preparation of functional AAV-based gene therapyvectors. Numerous references to various methods of AAV production,purification and preparation for administration to human subjects can befound in the extensive body of published literature (see, e.g., ViralVectors for Gene Therapy: Methods and Protocols, ed. Machida, HumanaPress, 2003). Additionally, AAV-based gene therapy targeted to cells ofthe CNS has been described in U.S. Pat. Nos. 6,180,613 and 6,503,888.Additional exemplary AAV vectors are recombinant AAV1, AAV2, AAV5, AAV6, AAV7 and AAV8 serotype vectors encoding human protein. Additionalexemplary pseudotyped vectors may be AAV vectors AAV2/1, AAV2/2, AAV2/6,AAV2/5, AAV2/7 and AAV2/8.

In certain methods of the invention, the vector comprises a transgeneoperably linked to a promoter. The transgene encodes a biologicallyactive molecule, expression of which in the CNS results in at leastpartial correction of neuropathology. The HIF1-alpha gene is well-knownin the art. See, e.g., NM_(—)001530. and NP_(—)001521. NFκκBtransactivation sequences can be substituted for the HIF 1-alphatransactivation sequence. See, e.g., NM_(—)003998.

The level of transgene expression in eukaryotic cells is largelydetermined by the transcriptional promoter within the transgeneexpression cassette. Promoters that show long-term activity and aretissue- and even cell-specific are used in some embodiments. Nonlimiting examples of promoters include, but are not limited to, thecytomegalovirus (CMV) promoter (Kaplitt et al. (1994) Nat. Genet.8:148-154), CMV/human β3-globin promoter (Mandel et al. (1998) J.Neurosci. 18:4271-4284), GFAP promoter (Xu et al. (2001) Gene Ther.8:1323-1332), the 1.8-kb neuron-specific enolase (NSE) promoter (Kleinet al. (1998) Exp. Neurol. 150:183-194), chicken beta actin (CBA)promoter (Miyazaki (1989) Gene 79:269-277), the 0-glucuronidase (GUSB)promoter (Shipley et al. (1991) Genetics 10:1009-1018), and ubiquitinpromoters such as those isolated from human ubiquitin A, human ubiquitinB, and human ubiquitin C as described in U.S. Pat. No. 6,667,174. Toprolong expression, other regulatory elements may additionally beoperably linked to the transgene, such as, e.g., the Woodchuck HepatitisVirus Post-Regulatory Element (WPRE) (Donello et al. (1998) J. Virol.72:5085-5092) or the bovine growth hormone (BGH) polyadenylation site.

For some CNS gene therapy applications, it may be necessary to controltranscriptional activity. To this end, pharmacological regulation ofgene expression with viral vectors can been obtained by includingvarious regulatory elements and drug-responsive promoters as described,for example, in Habermaet al. (1998) Gene Ther. 5:1604-16011; and Ye etal. (1995) Science 283:88-91.

In certain embodiments, the concentration or titer of the vector in thecomposition is at least: (a) 5, 6, 7, 8, 9, 10, 15, 20, 25, or 50 (×10¹²gp/ml); (b) 5, 6, 7, 8, 9, 10, 15, 20, 25, or 50 (×10⁹ tu/ml); or (c) 5,6, 7, 8, 9, 10, 15, 20, 25, or 50 (×10¹⁰ iu/ml).

In one aspect, the transgene encodes a biologically active molecule,expression of which in the CNS results in at least partial correction ofneuropathology. In some embodiments, the therapeutic transgene productis an HIF1-alpha protein that alleviates and/or prevents the symptoms ofALS. See Raoul et al. (2005) Nat. Med. 11(4):423-428 and Ralph et al.(2005) Nat. Med. 11 (4):429-433.

Additional or alternative transgenes can be used to express atherapeutic amount of insulin growth factor-1 (IGF-1), calbindin D28,parvalbumin, HIF1-alpha, SIRT-2, VEGF, SMN-1, SMN-2, and CNTF (Ciliaryneurotrophic factor).

The subject invention provides methods to modulate, correct or augmentmotor function in a subject afflicted with motor neuronal damage. Forthe purpose of illustration only, the subject may suffer from one ormore of amytrophic lateral sclerosis (ALS), spinal bulbar muscularatrophy, spinal muscular atrophy (SMA), spinal cerebellar ataxia,primary lateral sclerosis (PLS), or traumatic spinal cord injury.

Without being limited as to theory, the pathology associated with motorneuron damage may include motor neuron degeneration, gliosis,neurofilament abnormalities, loss of myelinated fibers in corticospinaltracts and ventral roots. Two types of onset are recognized: bulbaronset, which affects brainstem motor neurons,(affects the facialmuscles, speech, and swallowing); and limb onset, which affects spinalcord motor neurons, is reflected by spasticity, generalized weakness,muscular atrophy, paralysis, and respiratory failure. In ALS, subjectshave both bulbar and limb onset. In PLS, subjects have bulbar onset.

The ability to organize and execute complex motor acts depends onsignals from the motor areas in the cerebral cortex, i.e., the motorcortex. Cortical motor commands descend in two tracts. The corticobularfibers control the motor nuclei in the brain stem that move facialmuscles and the corticospinal fibers control the spinal motor neuronsthat innervate the trunk and limb muscles. The cerebral cortex alsoindirectly influences spinal motor activity by acting on the descendingbrain stem pathways.

The primary motor cortex lies along the precentral gyrus in Broadmann'sarea (4). The axons of the cortical neurons that project to the spinalcord run together in the corticospinal tract, a massive bundle of fiberscontaining about 1 million axons. About a third of these originate fromthe precentral gyrus of the frontal lobe. Another third originate fromarea 6. The remainder originates in areas 3, 2, and 1 in the somaticsensory cortex and regulate transmission of afferent input through thedorsal horn.

The corticospinal fibers run together with corticobulbar fibers throughthe posterior limb of the internal capsule to reach the ventral portionof the midbrain. They separate in the pons into small bundles of fibersthat course between the pontine nuclei. They regroup in the medulla toform the medullary pyramid. About three-quarters of the corticospinalfibers cross the midline in the pyramidal decussation at the junction ofthe medulla and spinal cord. The crossed fibers descend in the dorsalpart of the lateral columns (dorsolateral column) of the spinal cord,forming the lateral corticospinal tract. The uncrossed fibers descend inthe ventral columns as the ventral corticospinal tract.

The lateral and ventral divisions of the corticospinal tract terminatein about the same regions of spinal gray matter as the lateral andmedial systems of the brain stem. The lateral corticospinal tractprojects primarily to motor nuclei in the lateral part of the ventralhorn and to interneurons in the intermediate zone. The ventralcorticospinal tract projects bilaterally to the ventromedial cell columnand to adjoining portions of the intermediate zone that contain themotor neuorons that innervate axial muscles.

In one aspect, the disclosed methods include administering to the CNS ofan afflicted subject a neurotrophic viral vector carrying a transgeneencoding a therapeutic product and allowing the transgene to beexpressed within the CNS near the administration site at a levelsufficient to exert a therapeutic effect as the expressed protein istransported via the CSF throughout the CNS. In addition, the vector maycomprise a polynucleotide encoding a biologically active moleculeeffective to treat the CNS disorder. Such biologically active moleculesmay comprise peptides including but not limited to native, fused, ormutated versions of full-length proteins, native, fused, or mutatedversions of protein fragments, synthetic polypeptides.

In an illustrative embodiment, the administration is accomplished bydirect injection of a high titer vector solution into the spinal cord ofa subject or patient.

In some embodiments, the methods comprise administration of a high titerneurotrophic vector carrying a therapeutic transgene so that thetransgene product is expressed at a therapeutic level at a first sitewithin the spinal cord. In some embodiments, the viral titer of thecomposition is at least: (a) 5, 6, 7, 8, 9, 10, 15, 20, 25, or 50 (×10¹²gp/ml); (b) 5, 6,7,8, 9, 10, 15, 20, 25, or 50 (×10⁹ tu/ml); or (c) 5,6, 7, 8, 9, 10, 15, 20, 25, or 50 (×10¹⁰ iu/ml).

In experimental mice, the total volume of injected AAV solution is forexample, between 1 to 20 μl. For other mammals, including the human,volumes and delivery rates are appropriately scaled. Treatment mayconsist of a single injection per target site, or may be repeated in oneor more sites. Multiple injection sites can be used. For example, insome embodiments, in addition to the first administration site, acomposition containing a viral vector carrying a transgene isadministered to another site which can be contralateral or ipsilateralto the first administration site. Injections can be single or multiple,unilateral or bilateral.

High titer AAV preparations can be produced using techniques known inthe art, e.g., as described in U.S. Pat. No. 5,658,776 and Viral Vectorsfor Gene Therapy: Methods and Protocols, ed. Machida, Humana Press,2003.

The following examples provide illustrative embodiments of theinvention. One of ordinary skill in the art will recognize the numerousmodifications and variations that may be performed without altering thespirit or scope of the present invention. Such modifications andvariations are encompassed within the scope of the invention. Theexamples do not in any way limit the invention.

EXAMPLES Example 1 rAA V Viral Vector Delivery of Transgene to theSpinal Cord

To date there have been relatively few studies that systematicallymonitor patterns of distribution of different serotypes of rAAV to thenervous system. One of the most informative suggested that rAAV2/1 andrAAV2/5 tended to exhibit higher transduction than rAAV2/2. In addition,retrograde transport of rAAV1 and rAAV5 has been observed [20]. Wetherefore conducted initial experiments to determine the relative uptakeand delivery of a number of AAV serotypes, using two routes of delivery,to cells in the spinal cord, focusing on motor neurons. These initialexperiments compared intraparenchymal spinal cord injection of AAVencoding for GFP (green fluorescent protein) to the intramuscularinjection of AAV encoding for GFP. Six different pseudotyped AAV vectorswere assessed including serotypes 2/1, 2/2, 2/5, 2/6, 2/7, and 2/8.

Intraspinal cord injections. Mice were anaesthetized by isofluraneinhalation and immobilized using a stereotaxic device. Groups of micewere injected with an AAV CBA-GFP vector; one group with each one of thefollowing serotypes: AAV2/1, AAV2/2, AAV2/5, AAV2/6, AAV2/7 and AAV2/8.Each mouse received a total of 2.5 e 10 DNAse resistant particles(DRPs). The dose was injected by intraparenchymal injection into thefollowing areas of the spinal cord the C6 region (within the cervicalregion), the T8/T9 region and the T13 region (within the thoracicregion), and the L3/L4 region (within the lumbar region). Fourmicroliters of virus were injected per site at a rate of 1microliter/minute.

Intramuscular injections. Groups of mice were injected with an AAVCBA-GFP vector; one group with each one of the following serotypesAAV2/1, AAV2/2, AAV2/5, AAV2/6, AAV2/7 and AAV2/8. Each mouse receivedfour injections of AAV; two injections into the quadriceps muscle andtwo injections into the gasctrocnemius muscle. Each mouse received atotal dose of 2.5 e 10 DNAse resistant particles (DRPs).

Whole brain, spinal cord and muscles were dissected. DNA was extractedvia Qiagen Dneasy™ kit. BGH (bovine growth hormone) Taqman™ assayanalysis was conducted on the brain, spinal cord, and muscles usingprimers and probes against the BGH sequence in the AAV CBA-GFP vector todetermine the number of vector genome copies in each tissue. Copy numberof BGH out of total DNA was determined. Immunohistochemistry was alsoperformed on the dissected spinal cords to detect each of thefollowing: 1) GFP to measure transgene expression, 2) Glial fibrillaryacidic protein (GFAP) to label glial cells, and 3) SM132 and NeuN tolabel neuronal cells.

FIG. 1 demonstrates the number of AAV vector genomes that were deliveredto the spinal cord by either spinal injections or by intramuscularinjections. More vector genomes were found in the spinal cords of micetreated with spinal injections AAV 2/7 and 2/8.

FIG. 2 shows the number of vector genomes that were delivered to thebrain following either spinal cord or intramuscular injection of the AAVvectors. Very little AAV vector was present in the brain. Significantdifferences were not apparent among the different treatment groups. Thedata demonstrates that there was little dissemination of vector to thebrain following direct spinal cord injection of any AAV serotype. Thismay be a safety advantage and suggests that vector remains in the areaof the spinal cord following spinal cord injection.

FIG. 3 shows the number of vector genomes that were delivered to themuscle following intramuscular injection of the AAV vectors.

The data demonstrates that direct spinal cord injection of AAV vectorsmediates greater gene transfer to the spinal cord as compared tointramuscular injection of the AAV vectors. This is demonstrated by thegreater number of AAV vector genomes measured in the spinal cord in miceinjected in spinal cord versus in the muscle with identical AAV vectors.In addition, the data demonstrates that the serotypes mediating thehighest spinal cord gene transfer in this experiment were AAV2/7 andAAV2/8.

Immunohistochemistry results demonstrate that spinal cord injection ofAAV vectors encoding for GFP resulted in significant GFP expression. GFPexpression was co-localized on cells expressing neuronal markers, SM132and NeuN. No co-localization of GFP was observed with GFAP, an astrogliamarker. The immunohistochemical results were similar for all of theserotypes tested. Following intramuscular injection, no GFP or few GFPpositive cells (mostly non-neuronal) were observed in the spinal cordafter intramuscular injections.

Example 2 Evaluation of AAV-HIF-1alphaNFκB in the Mouse Brain

Injection of AAV-HIF1alphaNFκB in the mouse brain: Mice were injectedwith AAV vectors encoding HIF 1 alphaNFκB in the thalamus area of thebrain. Two serotypes were evaluated 1) AAV2/1-HIF1alphaNFκB and 2)AAV2-HIF1alphaNFκB. Each mouse received 9 e9 DNAse resistant particles(DRPs). Untreated mice served as controls. Four weeks post-injection,the mice were killed and their brains were collected. In situhybridization was performed on brain sections to visualize HIF-1 alphamRNA. RT-PCR was also performed on cDNA extracted from the brains toevaluate VEGF gene expression. VEGF gene expression was normalized toGUSB gene expression.

HIF-1alpha mRNA was observed via in situ hybridization in brains of micetreated with both AAV2/1-HIF1alphaNFκB and AAV2-HIF1alphaNFκB; nomessage was observed in the control brains. More HIF-1 alpha mRNA signalwas observed in mice treated with AAV2/1-HIF1alphaNFκB. Gene expressionanalysis by RT-PCR demonstrated an increase in VEGF gene expression inmice treated with AAV2/1-HIF1alphaNFκB relative to control animals. Nomeasurable increase in VEGF gene expression was observed in mice treatedwith AAV2-HIF1 alphaNFκB.

In a second experiment, mice were injected with AAV2/1-HIF1alphaNFκBbilaterally into the cerebellum area of the mouse brain. Each mousereceived 2 e10 DNAse resistant particles (DRPs). Untreated mice servedas controls. Three weeks post-injection, the mice were killed and theirbrains were collected. In situ hybridization was performed on brainsections to visualize HIF-1alpha mRNA. RT-PCR was also performed on cDNAextracted from the brains to evaluate VEGF, EPO, and IGF-1 geneexpression. Expression levels were normalized to GUSB gene expression.

HIF-1alpha mRNA was observed via in situ hybridization throughout thecerebellum. Expression was robust and was present throughout variousneuronal cell layers. No HIF-1alpha mRNA was observed in the brainstem.HIF-1alpha mRNA was not observed in the brains of control mice. As shownin FIG. 4, VEGF, EPO, and IGF-1 mRNA levels were upregulated in thebrain following transduction with an AAV vector encoding for HIF-1alpha.No upregulation in these genes was observed in control mice. Thisdemonstrates that HIF-1alpha has the ability to modulate gene expressionlevels in target genes in the brain following transduction with an AAVvector.

Example 3 rAAV-Mediated Delivery of HIF-1Alpha to the Spinal Cord of ALSMice

Therapeutically Relevant Model of Amyotrophic Lateral Sclerosis (ALS).Amytrophic lateral sclerosis (ALS) is a fatal neurodegenerative diseasethat is characterized by a selective loss of motor neurons in thecortex, brain stem and spinal cord. Progression of the disease can leadto atrophy of limb, axial and respiratory muscles. Motor neuron celldeath is accompanied by reactive gliosis, neurofilament abnormalities,and a significant loss of large myelinated fibers in the corticospinaltracts and ventral roots. Although the etiology of ALS is poorlyunderstood, accumulating evidence indicates that sporadic (SALS) andfamilial (FALS) ALS share many similar pathological features; thus,providing a hope that the study of either form will lead to a commontreatment. FALS accounts for approximately 10% of diagnosed cases, ofwhich 20% are associated with dominantly inherited mutations in Cu/Znsuperoxide dismutase (SOD1). Transgenic mice that express the mutanthuman SOD1 protein (e.g., SOD1^(G93A) mice) recapitulate manypathological features of ALS and are an available animal model to studyALS. For SALS, a myriad of pathological mechanisms have been implicatedas the underlying cause, including glutamate induced excitotoxicity,toxin exposure, proteasome dysfunction, mitochondrial damage,neurofilament disorganization and loss of neurotrophic support.

We will test the hypothesis that rAAV-mediated delivery of HIF 1 alphato the spinal cord can promote motor neuron survival and ameliorate thedisease progression of SOD1^(G93A) ALS mice. Delivery with a recombinantAAV vector permits relatively long-term transgene expression (ALS micemay require transgene expression for many months. Moreover, depending onthe serotype, AAV infects both neuronal and non-neuronal cells, apotential benefit if, as we suspect, non-neuronal cells participate inthe death of the motor neurons [21].

Experimental outline. We used intraspinal injections to administerAAV2/8-HIF1alpha NFκB to determine of the effect of this strategy onmotor neuron survival and disease onset and survival of ALS SOD1^(G93A)mice.

rAA V infection of spinal cord of ALS mice. For each viral treatmentgroup, SOD1^(G93A) or SOD1WT mice (5/group) and WT mice (5/group) either60 days old or 90 days old were injected with 1e 11 DRPs ofAAV2/8-Hif1alpha-NFκB. As negative controls, SOD1 mice either 60 daysold or 90 days old were injected with the same dose of empty vector. (Asan additional positive control, SOD1 mice (5/group) either 60 days oldor 90 days old could be injected with the same dose of AAV2/8-hIGF-1(human IGF-1) vector. An additional negative control could also bewild-type mice.) Virus was injected into vertebrae C6, T8/T9, T13, L3/L4of the spinal cord, 4 μl per site, delivered at 1 μl/min, with 2.5 e 10DRP total dose. TaqMan assays will be used to detect viral genomes,message for HIF1alpha, and VEGF, in the spinal cord. In situhybridization of spinal cords was performed to visualize HIF 1-alphaexpression in the spinal cords of both AAV2/8-Hif1alpha-NFκB treated andnegative control mice.

Sample size and statistical considerations. Twenty TgSOD1^(G93A) micewere treated with AAV2/8-HIF1alpha to be observed for onset andsurvival. An additional 30 mice of each type could be sacrificed forhistological and biochemical analysis at 110d and terminally. Based onprevious studies, we assume (i) mice with SOD1^(G93A) transgene live130±13 days; (ii) the statistical power of our study to detect thetrue-intergroup difference is 90%; (iii) alpha is two-tailed at 0.05;and (iv) we wish to detect a 10% or greater difference in mean survivalof treated mice. With these assumptions, we require a minimum of 14 miceper test haplotype. We therefore elected to observe at least 20 animalsin each group for onset, disease progression and survival, in case micedie for reasons unrelated to their motor neuron disease. In the finalsurvival analysis, 20 mice treated with AAV2/8-HIF 1 alpha wereevaluated and 18 control mice were evaluated. An additional 30 mice pergroup could be sacrificed for histological and biochemical analysis atpre-determined time intervals (5 per month×6 months). Time of diseaseonset and survival was compared using Kaplan-Meier plots and thelog-rank statistical test. A Cox-proportional hazards model will beemployed to control for the effects of gender.

Determination of the effect of rAA V-HIF1alpha on the ALS phenotope.Disease onset is defined by the appearance of tremors in theoutstretched legs when the mouse is held up by its tail. Death isdefined as that point at which the mouse cannot right itself within 30seconds.

Assessment of effect of rAAV-HIF1alpha on motor neuron survival. We willuse ventral root analysis to monitor motor neuron numbers on 5TgSOD1^(G93A) mice treated with rAAV-HIF1alpha at symptomatic (110 days)and end-stage time points.

Results. A statistically significant (p=0.033) increase in survival ofALS mouse following intraspinal administration of AAV2/8 Hif1aNFkB wasobserved (133 days survival control vs 139 day survival experimentalanimals). Different cohorts of animals responded differently to thetreatment; 25% of the treated animals showed an increase in survival of18-23 days while 25% of the animals showed an increase in survival of8-13 days. In situ hybridization analysis for Hif1aNFkB in the spinalcords of ALS mice treated with AAV2/8 Hif1aNFkB suggests thattransduction was seen mainly in the lumbar region of the spinal cord. Inaddition, the analysis suggests that only 25% of the intended dose of 1e11 drps was given to the animals.

TABLE 1 Survival Summary Table for Column 1 Censor Variable: Column 3Grouping Variable: Column 1.2 # # # % # # Obs. Events Censored CensoredMissing Invalid CONTROL 18 13 5 27.778 0 0 EXP 20 20 0 0.000 0 0 Total38 33 5 13.158 0 0

TABLE 2 Kaplan-Meier Survival Statistics for Column 1 Censor Variable:Column 3 Grouping Variable: Column 1.2 Estimate Std. Error CONTROL: 25%129.000 4.992 CONTROL: 50% 134.000 2.996 CONTROL: 75% 139.000 1.519CONTROL: Mean 133.000 2.169 EXP: 25% 131.000 4.782 EXP: 50% 139.0002.966 EXP: 75% 144.000 3.873 EXP: Mean 138.100 2.334

Example 4 Hybrid/Chimera Construction

A hybrid transcription factor (pcDNA3/HIF.VP-16.Afl2) composed of aDNA-binding and dimerization domain from HIF-1α and the transactivationdomain from herpes simplex virus VP16 may be constructed to providestrong, constitutive activation of genes normally involved in thephysiological adaptation to hypoxia as outlined below.

The full-length (aa 1-826) HIF-1α gene was isolated by PCR (AdvantagecDNA PCR Kit, Clontech, Palo Alto, Calif.) from a HeLa cell cDNA library(Clontech) using the primers set forth (SEQ ID NO:: ggggtaccttctcttctccg cgtgtggagg gagccagc; SEQ ID NO:: gctctagagt gagccaccagtgtccaaaaa aaggatg) and inserted between the KpnI and XbaI sites of theexpression vector, pcDNA3 (Invitrogen, Carlsbad, Calif.). In thisplasmid, gene expression is controlled by the cytomegalovirus (CMV)immediate early enhancer/promoter. The HIF-1α/VP-16 hybrid wasconstructed by truncating HIF-1a at aa 390 (an Afl2 site) and thenjoining the transactivation domain of HSV VP-16 downstream. A VP16fragment (aa 413-490) with Afl2 and XbaI ends was amplified by PCR usingVent polymerase (New England Biolabs, Beverly, Mass.) and the primersset forth (SEQ ID NO:: cgtacgctta agccggaatt cccggggatc tgg; SEQ ID NO::cgctctagac tacccaccgt actcgtcaat tc) and this fragment was cloned intothe appropriate sites of the pcDNA3/HIF-1α construct. A relatedconstruct (pcDNA3/HIF/VP-16/R1) was produced by truncating HIF-1α at aa530 by partial digestion with EcoR1. The integrity of all sequencesgenerated by PCR was verified by DNA sequencing using an AppliedBiosystems 377 DNA Sequencer. All cloning manipulations were carried outfollowing standard procedures (Sambrook, J. et al., Molecular Cloning, ALaboratory Manual 2d Ed. (Cold Spring Harbor, N.Y., 1989)). Restrictionenzymes and DNA-modifying enzymes were obtained from ether New EnglandBiolabs or Life Technologies, Inc. (Gaithersburg, Md.) and usedaccording to the manufacturer's specifications. Plasmid DNAs werepurified with kits obtained from Qiagen (Chatsworth, Calif.).

Unless otherwise indicated, all numbers expressing quantities ofingredients, cell culture, treatment conditions, and so forth used inthe specification, including claims, are to be understood as beingmodified in all instances by the term “about.” Accordingly, unlessotherwise indicated to the contrary, the numerical parameters areapproximations and may very depending upon the desired properties soughtto be obtained by the present invention. Unless otherwise indicated, theterm “at least” preceding a series of elements is to be understood torefer to every element in the series. Those skilled in the art willrecognize, or be able to ascertain using no more than routineexperimentation, many equivalents to the specific embodiments of theinvention described herein. Such equivalents are intended to beencompassed by the following claims.

REFERENCES

-   1. Rosen, D. R., et al., Mutations in Cu/Zn superoxide dismutase    gene are associated with familial amyotrophic lateral sclerosis.    Nature, 1993. 362: p. 59-62.-   2. Andersen, P. M., et al., Sixteen novel mutations in the Cu/Zn    superoxide dismutase gene in amyotrophic lateral sclerosis: a decade    of discoveries, defects and disputes. Amyotroph Lateral Scler Other    Motor Neuron Disord, 2003. 4(2): p. 62-73.-   3. Cleveland, D. W. and J. D. Rothstein, From Charcot to Lou Gehrig:    deciphering selective motor neuron death in ALS. Nat Rev    Neurosci, 2001. 2(11): p. 806-19.-   4. Gurney, M. E., et al., Motor neuron degeneration in mice that    express a human Cu, Zn superoxide dismutase mutation. Science, 1994.    264: p. 1772-1775.-   5. Gurney, M. E., et al., Benefit of vitamin E, riluzole, and    gabapentin in a transgenic model of familial amyotrophic lateral    sclerosis [see comments]. Ann Neurol, 1996. 39(2): p. 147-57.-   6. Drachman, D. B., et al., Cyclooxygenase 2 inhibition protects    motor neurons and prolongs survival in a transgenic mouse model of    ALS. Ann Neurol, 2002. 52(6): p. 771-8.-   7. Kieran, D., et al., Treatment with arimoclomol, a coinducer of    heat shock proteins, delays disease progression in ALS mice. Nat    Med, 2004. 10(4): p. 402-5.-   8. Dobrowolny, G., et al., Muscle expression of a local Igf-1    isoform protects motor neurons in an ALS mouse model. J Cell    Biol, 2005. 168(2): p. 193-9.-   9. Kaspar, B. K., et al., Retrograde viral delivery of IGF-1    prolongs survival in a mouse ALS model. Science, 2003. 301(5634): p.    839-42.-   10. Iwasaki, Y., et al., Protective effect of interleukin-3 and    erythropoietin on motor neuron death after neonatal axotomy. Neurol    Res, 2002. 24(7): p. 643-6.-   11. Brockington, A., et al., Vascular endothelial growth factor and    the nervous system. Neuropathol Appl Neurobiol, 2004. 30(5): p.    427-46.-   12. Storkebaum, E., D. Lambrechts, and P. Carmeliet, VEGF: once    regarded as a specific angiogenicfactor, now implicated in    neuroprotection. Bioessays, 2004. 26(9): p. 943-54.-   13. Lambrechts, D., et al., VEGF is a modifier of amyotrophic    lateral sclerosis in mice and humans and protects motoneurons    against ischemic death. Nat Genet, 2003. 34(4): p. 383-94.-   14. Oosthuyse, B., et al., Deletion of the hypoxia-response element    in the vascular endothelial growth factor promoter causes motor    neuron degeneration. Nat Genet, 2001. 28(2): p. 131-8.-   15. Azzouz, M., et al., VEGF delivery with retrogradely transported    lentivector prolongs survival in a mouse ALS model. Nature, 2004.    429(6990): p. 413-7.-   16. Zheng, C., et al., Vascular endothelial growth factor prolongs    survival in a transgenic mouse model of ALS. Ann Neurol, 2004.    56(4): p. 564-7.-   17. Storkebaum, E., et al., Treatment of motoneuron degeneration by    intracerebroventricular delivery of VEGF in a rat model of ALS. Nat    Neurosci, 2005. 8(1): p. 85-92.-   18. Yamakawa, M., et al., Hypoxia-inducible factor-1 mediates    activation of cultured vascular endothelial cells by inducing    multiple angiogenic factors. Circ Res, 2003. 93(7): p. 664-73.-   19. Vincent, K. A., et al., Angiogenesis is induced in a rabbit    model of hindlimb ischemia by naked DNA encoding an HIF-1alpha/VP16    hybrid transcription factor. Circulation, 2000. 102(18): p. 2255-61.-   20. Burger, C., et al., Recombinant AA V viral vectors pseudotyped    with viral capsids from serotypes 1, 2, and 5 display differential    efficiency and cell tropism after delivery to different regions of    the central nervous system. Mol Ther, 2004. 10(2): p. 302-17.-   21. Clement, A. M., et al., Wild-type nonneuronal cells extend    survival of SOD1 mutant motor neurons in ALS mice. Science, 2003.    302(5642): p. 113-7.

1. A method of treating a mammal with a motor neuron disorder,comprising the steps of: injecting a recombinant expression vectorencoding HIF 1-alpha into the spinal cord of a mammal with a motorneuron disorder whereby life expectancy is extended.
 2. The method ofclaim 1 wherein the recombinant vector is an adenovirus associatedvector.
 3. The method of claim 2 wherein pseudotype of the adenovirus is2/7.
 4. The method of claim 2 wherein pseudotype of the adenovirus is2/8.
 5. The method of claim 1 wherein the vector is delivered into aplurality of sites in the spinal cord.
 6. The method of claim 1 whereinthe vector encodes a fusion protein of HIF1-alpha and HSV VP
 16. 7. Themethod of claim 1 wherein the vector encodes a fusion protein ofHIF1-alpha and NFκB.
 8. The method of claim 1 wherein the mammal has acondition selected from the group consisting of spinal bulbar muscularatrophy, spinal cerebellar ataxia, spinal muscular atrophy, andtraumatic spinal cord injury.
 9. The method of claim 1 wherein themammal has ALS.
 10. The method of claim 1 wherein the mammal is selectedfrom the group consisting of a rodent, a murine, a human, and a simian.11. The method of claim 1 wherein said mammal is a human patient.
 12. Amethod of treating a human patient with a motor neuron disorder,comprising the steps of: delivering to a plurality of sites in spinalcord of a human patient with a motor neuron disorder a recombinant AAVpseudotype 2/7 or 2/8 vector encoding HIF 1-alpha fused to NFκB, wherebylife expectancy is extended.
 13. The method of claim 11 or 12 whereinthe human patient has a condition selected from the group consisting ofspinal bulbar muscular atrophy, spinal cerebellar ataxia, spinalmuscular atrophy, and traumatic spinal cord injury.
 14. The method ofclaim 11 or 12 wherein the human patient has amytrophic lateralsclerosis (ALS).
 15. A recombinant gene delivery vector for treatingpatients with a motor neuron disorder, comprising: a recombinant AAVpseudotype 2/7 or 2/8 vector encoding HIF1-alpha.
 16. The vector ofclaim 15 wherein the HIF1-alpha is fused to NFκB.
 17. The vector ofclaim 16 wherein the HIF1-alpha is fused to NFκB is encoded by anucleotide sequence as shown in SEQ ID NO:
 1. 18. The method of claim 7wherein the fusion protein is encoded by a nucleotide sequence as shownin SEQ ID NO: 1.